Medication Mishap

[Amethya]

Got a student who has ADHD badly and she tends not want to take her medication and I was told in the beginning that she's a liar and that we need to keep an eye on her to take her medication. I wanted to trust her and help her, but sadly it didn't work out.

Today she came to take her medication. I gave it to her like always, and she proceded to go to the water fountain to take her meds. The secretary called out to me and told me she threw away the medication. I then proceded to give her another one, which this time I saw her take it.

My AP called me and asked me if she took her medication or not, and I told her she threw away the first pill and I gave her another one. She got upset because she said we didn't see her take the medication and gave her one, and the child told her she took it, but opened the capsule and took the contents. She never has done that with me, she always took the pill whole. Then the child changed the story to that she didn't take it.

My AP was upset with me because she said that I'm not doing my end of the bargain which was watching her take her medication and that yesterday was the second time I didn't give it to her on time.

I explained to her that yes, it was my mistake I didn't check before I gave her another dose, but I can't do anything if she doesn't take her medication.

She is upset, and wants to talk to my principal, which I did before her, explaining that I'm not sure how we can do this with this child, she is difficult and I now know why we can't trust her.

I wanted to give her trust but obviously she can't be trusted. It was my mistake and I am trying to fix this situation by finding a solution, but I'm not sure how I can defend myself when I talk to my AP.

I know this will be another written warning and I will write a rebuttal but I'm not sure how I can defend myself on this.

Yes, it was my fault, and I made a mistake and I'm willing to fix the situation, but what I do I tell her.

[AJJKRN]

I figured out what happened. I'm not sure how in the hell this brat did this, but she didn't even take my second pill.

She was acting out a lot today, which is one clue, giving issues to all and even the person testing her today. She came to harass me for another pill but I didn't give her any because I was under direct orders from my AP just in case of overdose.

Then another clue is today she hasn't come to cry about her stomach hurting or vomiting because her medication causes her to have sever stomach pains and vomiting. Same with eating, she doesn't eat and she ate today.

So I wrote my statement and explained yes I made a mistake and I will make sure not to do it again but she did not take any medications today. Both pills were empty, she emptied the contents somewhere, and I don't know how.

Are you serious? This "brat" isn't the one that made the mistake! If the kid gets severe stomach pains, vomits, and can't eat on her medicine do you really not understand her "difficult" behavior. Aren't you the adult?

Regardless of whether you truly want to help children and need your job, I find your reasoning both extremely jaded and dangerous. I have yet to meet a MA that has the skills and education to appropriately give medications. Your actions should have consequences...from somebody...like a state board or something and then maybe there would be a greater incentive to get your act together and keep it together.

Geez, I did try to stay out of it but repeatedly bashing/blaming a child that is acting like a child just frustrates me to no end.

[SafetyNurse1968, ADN, BSN, MSN, PhD]

I worked in an adult day center and their policy was to watch the patient swallow the pill, but they were not allowed to request the patient open their mouth after swallowing to ensure they actually did swallow (regardless of past actions...those who routinely spit out pills later were treated the same as those who didn't). Actually they didn't call them patients, but "clients" - the idea was to respect them, and preserve their dignity. Interesting how differently we view a teenager. This brings up so many issues - most all of them have been covered in the comments regarding controlled substances, changing policy, transparency surrounding error. I think its also important to bring up the concept of patient rights. When you are under 18, do you have any right to dignity? Not advocating either way - its just an interesting question. The parents ultimately have the final say in how you deal with this child, yes? So talking to them is the most important step. You might also consider reporting this to the ISMP - they not only track and record medication errors, but can provide you with much needed support. Report Medication Error To ISMP

If a report is made to the board of nursing, promise me you will talk to a lawyer - too many nurses go before the board without adequate support. Thank you for sharing - this kind of thing is so hard to get through - all the feelings...sigh. I have been there. As nurses I feel like the culture is that we are supposed to somehow just know better and do it all right the first time - so little room for humanity! Keep talking about it.

[Been there,done that, ASN, RN]

You put yourself under the bus. You must always do a mouth check. No away in Hades, would I give another dose.

[Viviana, ASN, RN]

Amethya,

What is an AP? You may want to consider buying lunch cups of Applesauce, put a spoonful of applesauce in a medication cup, then open the capsule into the applesauce and administer with a spoon. Never, ever allow medication to leave your administration area. It should be swallowed, and a buccal check done to assure that the med has not been cheeked or placed under the tongue.

[Amethya]

Are you serious? This "brat" isn't the one that made the mistake! If the kid gets severe stomach pains, vomits, and can't eat on her medicine do you really not understand her "difficult" behavior. Aren't you the adult?

Regardless of whether you truly want to help children and need your job, I find your reasoning both extremely jaded and dangerous. I have yet to meet a MA that has the skills and education to appropriately give medications. Your actions should have consequences...from somebody...like a state board or something and then maybe there would be a greater incentive to get your act together and keep it together.

Geez, I did try to stay out of it but repeatedly bashing/blaming a child that is acting like a child just frustrates me to no end.

I'm sorry you feel this way. I tried to be extremely patient with this child, and it's hard. Yes I did make a mistake and I already talked it out with the people in charge of me.

The reason I'm upset with the child because my trust with her is gone and it was my fault for trying to trust her.

Before she came here I was told by her files and such that she's a compulsive liar and manipulative, very hard to reason and very defiant. I was warned on this behavior, but I wanted to give her a chance. As someone with ADD, I kind of understood her difficulties and wanted to help.

Before I gave her the first dose, I explained to her that I want to trust her and work with her on this. But as time went on I saw and been told if things happening, both students and staff. She's violent and aggressive , constantly fighting and acting out. I tried to talk to her, our counselor and AP tried to work with her and her mother asked me basically to do the tongue check because she will not take her medication at home. It's a struggle for us here with her and she refuses to cooperate! I understand why she's like this because of my research on psychology and personal experience.

I have suggested mother that if she feels the medication is not a good fit to go talk to her doctors to see what other medications they can try.

But today it became apparent that I can't trust this kid. I want to but I can't now.

I understand that what I'm writing seems mean but it's hard to understand from my perspective and I'm honestly trying to help her.

I can't force her to take her medications but I'll try my best with her.

i forgot to mention she's a 13 year old girl.

[Been there,done that, ASN, RN]

I honestly don't feel supported. The person in charge of me is always getting up on my case on things, and throws me under a bus when something happens. Then the person above me, doesn't like me and is always upset with me.

I'm honestly not comfortable here anymore, because while I understand I do mistakes, I'm not a nurse and I keep getting in trouble for things I wasn't told what to do for things that happen.

I really want to find another job, but I don't want to work in clinics anymore, but in schools, helping an RN doing her job with children.

Wherever you work, they should not have you administer medication.

[SaltineQueen]

I will never, ever let any medication with street value out of my office unless it's been swallowed in my office. Change your policy immediately and you will then lose the she said/she said about whether the student took the med or not.

As far as re-administering...do you have anyone with a nursing degree in your district whom you could ask that question?

Child no longer has your trust. You've changed the way you do business. End of story.

I'm late to the party, but I agree with this. Kids take their meds in front of me, controlled substance or not. I've had kids who we thought were cheeking meds & I made them show me their (hopefully empty) mouth. No more taking meds to the drinking fountain, period.

[Flare, ASN, BSN]

You can't blame the 13 year old here. Heck, i've had 8th grade students that have appeared to swallow pills only to find out that they've been cheeking them and spitting them out later to prove that they don't need them. You can be sure that when I figured out that was happening, the trust was gone, and that child spent the rest of his time with me doing a swallow and then opening his mouth "wide, like a lion" he hated that - but you have to control the situation. With grace and tact. Even now, i have a smaller one that doesn't really give me problems with taking her medication - but won't swallow her pill unless prompted - she will stand there and hold it in her mouth (yuck) and the kicker is the reason she does that is because she says she hates the taste of it. I have tried to explain over and over again that if she were to just swallow it quickly she wouldn't taste it - but that message hasn't gotten through yet. So we continue to do this dance and she does NOT leave my office until she opens that mouth.

I like the idea given to seek work as a paraprofessional or nurses' aide type position in the school. I really do feel that the OP does care for children and does have their best interests at heart - but I feel that the cumulative posts show a pattern of being overwhelmed by this job and a lack of support by the rest of the staff and admins. A job working one on one with a child with needs may be the right fit.

[OhioBPH]

I have yet to meet a MA that has the skills and education to appropriately give medications.

I find this pretty insulting. As a CMA with 7 years of experience giving medications and injections I have an incredibly low error rate, and have made no errors while working in school health.

Our department is managed by a local children's hospital and we have detailed policies and training and strict rules to follow within the the clinic. We also have a district nurse as well as a whole administrative team available just a phone call away. Every new med that comes in, the RN comes to review the order, and it is administered by me, and MA. Most of our districts utilize MAs in clinics if there is not a demanding medical situation within the school. We are quite successful as a department, and have a strong reputation within our region.

I think the ability of a MA to pass meds adequetly is all in the training and policies. There is another organization here that staffs clinics with MAs and they are terrible, but even their nurses are terrible.

Its frustrating to see nurses making sweeping generalizations about medical assistants as a whole. The educational process and training varries greatly from school to school and workplace to workplace. Just like any job there are bad ones and good ones.

[JenTheSchoolRN, BSN, RN]

I find this pretty insulting. As a CMA with 7 years of experience giving medications and injections I have an incredibly low error rate, and have made no errors while working in school health.

Our department is managed by a local children's hospital and we have detailed policies and training and strict rules to follow within the the clinic. We also have a district nurse as well as a whole administrative team available just a phone call away. Every new med that comes in, the RN comes to review the order, and it is administered by me, and MA. Most of our districts utilize MAs in clinics if there is not a demanding medical situation within the school. We are quite successful as a department, and have a strong reputation within our region.

I think the ability of a MA to pass meds adequetly is all in the training and policies. There is another organization here that staffs clinics with MAs and they are terrible, but even their nurses are terrible.

Its frustrating to see nurses making sweeping generalizations about medical assistants as a whole. The educational process and training varries greatly from school to school and workplace to workplace. Just like any job there are bad ones and good ones.

Sounds like you have wonderful support and training, which is great! I think that is essential and with it MAs are invaluable in a school setting.

But I don't think the OP has that support or training, which just stinks for everyone - her, the kids, the staff.

[OhioBPH]

But I don't think the OP has that support or training, which just stinks for everyone - her, the kids, the staff.

I agree, and she has supported that. And it does stink. I just get my feathers ruffled when my profession is disregarded. It also makes me apprehensive about entering nursing school, because I do not want my teachers, peers, and preceptors to assume that my experience has no value.

[tining, BSN, RN]

This is a terrible situation. At first I thought OP was an RN and was internally roasting her for the error. After reading through and realizing she has a position in which she does not have the skills qualified for the job, shame on the school for having a staff member give pills to kids who are not nurses. I feel for you OP. I see that you are in a hard place. You clearly love kids, need a job and want to help, and know you are in over your head. I don't think you go to work thinking "I can't wait to harm a child today!" It's a very hard position to be in I am sure. I do empathize with what you are going through.

I would be direct with what happened. Don't get into any emotional aspects, just the facts, as anything more will shake you up and it won't bode well.

Write a statement, one of the facts of what happened, what you plan to do personally to fix it and what you plan to do policy wise to fix it.

Good luck.

I am being harsher towards Amethya as her many previous posts have alarmed me and I am trying to convince her that her reputation is on the line and student safety. For the student/patient/client safety I will stick my neck out to be a bad guy. She is inadequately supervised at this charter school. There are other MA's who do a fantastic job and I am guessing they have adequate support. There is a history with this OP being overwhelmed and definitely not supported by her office or Lead Nurse. I believe she would be valuable in a different kind of position with children.